Department of Urology, School of Medicine, Kyungpook National University , Daegu, Korea.
J Endourol. 2013 Oct;27(10):1209-12. doi: 10.1089/end.2013.0347. Epub 2013 Sep 17.
Preoperative percutaneous nephrostomy (PCN) has been commonly performed for patients with urinary stones complicated with pyelonephritis or obstructive uropathy; in fact, a considerable number of patients undergo ureteroscopic removal of stone (URS) in the presence of a PCN. We assessed the effectiveness of PCN during URS in the management of upper ureteral stones.
We retrospectively analyzed 140 patients who underwent URS for upper ureteral stones between January 2008 and December 2011. All URS were performed by a single experienced surgeon. The subjects were divided into two groups depending on the presence of a PCN at the time of the surgery (PCN group: 42 and non-PCN group: 98). The PCN group was subdivided into two groups depending on the performance of external fluid irrigation through PCN during the surgery (irrigation group: 21 and non-irrigation group: 21). To evaluate operative outcomes, we compared operative times, auxiliary procedures required, and success and complication rates.
The PCN group showed significantly better outcomes in terms of the operative time (57.4 minute vs. 68.1 minute) and success rate (92.9% vs. 78.6%) without increasing the complication rate. In the PCN group, the irrigation group showed a shorter operative time compared to the non-irrigation group, although statistical significance was not observed. Other perioperative outcomes, such as the success rate, auxiliary procedures, and complication rates, were not significantly different between the two groups.
URS for upper ureteral stones in patients with PCN produced superior surgical outcomes in terms of the success rate, operative time, and auxiliary procedure rate without increasing the complication rate. The presence of PCN with/without external irrigation during URS can be a beneficial factor to produce better outcomes of URS for the management of upper ureteral stones.
术前经皮肾造瘘术（PCN）常用于治疗合并肾盂肾炎或尿路梗阻的尿路结石患者；实际上，相当数量的患者在 PCN 存在的情况下接受输尿管镜碎石术（URS）。我们评估了 PCN 在处理输尿管上段结石时在 URS 中的有效性。
我们回顾性分析了 2008 年 1 月至 2011 年 12 月期间 140 例接受 URS 治疗的输尿管上段结石患者。所有 URS 均由一位经验丰富的外科医生完成。根据手术时是否存在 PCN 将患者分为两组（PCN 组：42 例，无 PCN 组：98 例）。PCN 组根据手术时是否通过 PCN 进行外部液体冲洗进一步分为两组（冲洗组：21 例，非冲洗组：21 例）。为了评估手术结果，我们比较了手术时间、所需辅助程序以及成功率和并发症发生率。
PCN 组的手术时间（57.4 分钟比 68.1 分钟）和成功率（92.9%比 78.6%）明显更好，而并发症发生率没有增加。在 PCN 组中，与非冲洗组相比，冲洗组的手术时间更短，但差异无统计学意义。两组之间的其他围手术期结果，如成功率、辅助程序和并发症发生率，无显著差异。
对于合并 PCN 的输尿管上段结石患者，URS 可以提高成功率、手术时间和辅助程序率，同时不增加并发症发生率，从而获得更好的手术效果。PCN 的存在与否以及在 URS 期间是否进行外部冲洗都可以成为提高 URS 治疗输尿管上段结石效果的有益因素。
